1. What is vascular access? Vascular access is a lifeline for hemodialysis patients. Because without a healthy and durable vascular access, you cannot deliver hemodialysis treatment to hemodialysis patients. The current maintenance hemodialysis treatment which is conducted two to three times per week has been possible with the invention of vascular access. Arteriovenous fistula (AVF), arteriovenous graft (AVG), non-tunneled hemodialysis catheter, and tunneled cuffed hemodialysis catheter are all included in vascular access for hemodialysis treatment. Among them, AVF and AVG are called arteriovenous (AV) access. Recently, AVF is divided into sAVF and pAVF according to whether is created by surgery or percutaneous endoAVF devices. The newly developed HeRO graft (Merit Medical) has both aspects of the AVG and centrally inserted catheter.  2. How is an arteriovenous access created? AVF is surgically created by direct anastomosis between the artery and superficial vein. AVG is surgically placed by anastomosis of the artery and vein to both ends of the conduit of a PTFE graft. The recently introduced endoAVF is made percutaneously by special devices without open surgery. Each type of AV access is associated with a certain pattern of clinical problems depending on the type, location, and anastomosed vessels. To cope with the challenges ahead, it is crucial to be familiar with the type and anatomical features of AV access placed for your patients.  3. What are the clinical impacts of AV access creation? Although vascular access is essential for hemodialysis treatment, it may cause many clinical problems for patients. Central venous catheters including a tunneled or non-tunneled hemodialysis catheter are relevant to central vein stenosis, catheter-related infection, catheter-related thrombus, and higher mortality compared to AV access. AV access including AVF and AVG is responsible for inappropriate dialysis adequacy if it has a low flow rate or contributes to the occurrence of structural heart disease if it has a high flow rate. Consequentially, both outcomes result in increased mortality in hemodialysis patients.  4. How can I maintain my patients’ AV access healthy? The updated NKF-KDOQI guidelines for vascular access divided AV access complications into three categories; Thrombotic flow–related complications, non-thrombotic flow–related complications, and Infectious complications. In addition, it emphasized the regular monitoring including physical examination by trained physicians to find clinical indicators associated with access dysfunction. The comprehension of the complications and their clinical indicators will help us to refer patients for interventional or surgical correction in a timely manner. Recently, the role of nephrologists in the diagnosis and treatment of AV access complications is expanding. We will deal with the way interventional nephrologists actively participate in the diagnosis and treatment of vascular access problems in the following presentations.